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David Lassen, chief clinical officer at Prime Therapeutics, discusses implications for specialty pharmacy from health care reform.

CMS announced the first mandatory test of shared-risk, outcomes-based payment model and the first initiative to make hospitals financially-responsible for patient recovery, 90-days after a knee or hip replacement surgery…The landmark program, Comprehensive Care for Joint Replacement, goes into effect April 1, 2016. Patient engagement and care coordination technology will be key to helping hospitals meet cost containment requirements…can lead to lower costs and increased healthcare quality…Healthcare institutions and leaders should know five items to move forward into the coordinated care initiative:

1. 789 hospitals will be impacted
2. 500,000 patients can participate, annually
3. Quality matters. Hospitals must adhere to strict quality metrics and keep down care costs from admissions to 90 days after discharge
4. Hospitals can donate $1,000 per Medicare beneficiary for patient engagement IT and services
5. CMS will provide incentives for Patient Reported Outcomes

Three Southern Nevada physicians were taken off regulatory probation Friday, including a Las Vegas orthopedic surgeon accused of throwing drug-fueled sex parties at his Henderson home and at the Trump Hotel…Dr. Andrew Martin declined to answer any questions after his appearance before the Nevada State Board of Medical Examiners at the Westgate…The board also lifted probation for Dr. Sean Su, a family practitioner barred by the board from performing cosmetic procedures, and Dr. Arlyn Valencia, a neurologist who failed drug tests.

...drug disposal is expensive — the Nebraska program spends $10 per pound to ship and destroy medication — and some states and municipalities want drug companies to pick up the tab…Six municipalities in California require drugmakers to pay for take-backs. Nine states...have considered similar measures...Proponents say these laws, which are similar to programs that require manufacturers to pay for electronics recycling, would make it easier for patients to dispose of prescriptions. But drugmakers oppose the local mandates and warn that disposal costs could be passed on to patients through higher drug prices…Alameda County in California was the first jurisdiction to pass a law requiring manufacturers to pay for take-backs, in 2012, though the industry was quick to file suit, arguing it violated the interstate commerce clause of the U.S. Constitution. The Alameda law was upheld this year when the Supreme Court refused to hear the industry’s appeal…Drugmakers would rather lead their own take-back programs than comply with local or state mandates, said Priscilla VanderVeer, of the Pharmaceutical Research and Manufacturers of America...Because drugmakers sell across the country, meeting the customized disposal requirements of local programs is complicated...There are also more effective ways to get rid of the medicines, she said, like at-home disposal or returning unwanted drugs using special envelopes with carbon lining…“That’s just a financial and logistical nightmare for something that’s not necessarily going to be effective, or secure or environmentally helpful,” she said.

The massive Pfizer-Allergan merger is getting a lot of attention. It is one of the largest takeovers ever in the healthcare industry, worth an estimated $160 billion…But consider another number: The amount Pfizer, Allergan and their predecessor companies have paid to settle government healthcare fraud allegations in the US – a total of nearly $4.5 billion. That total doesn’t include close to $1 billion paid to settle related consumer actions…Add to that the six criminal pleas and four corporate integrity agreements that the companies and their predecessor subsidiaries have agreed to, and one might question whether cheating and corruption are part of their “corporate DNA.”… The duo’s “hall of shame” is staggering and impossible to overlook. Here are some of the settlements the two corporations and/or their predecessor companies have paid the US and states:

•     Pfizer/Parke Davis/Warner Lambert — $430 million settlement and a criminal plea. (2004)
•     Pfizer/Pharmacia & Upjohn Co. — $2.3 billion and a criminal plea. (2009)
•     Allergan — $600 million and a criminal plea. (2010)
•     (Allergan/Actavis) Forest Labs — $313 million and a criminal plea. (2010)
•     Pfizer — $14.5 million. (2011)
•     (Allergan/Actavis) Watson Pharmaceuticals — $1.7 million. (2012)
•     Pfizer/Wyeth Pharmaceuticals — $491 million and a criminal plea. (2013)
•     Allergan/Actavis/Watson Pharmaceuticals — $12.4 million. (2013)
•     Pfizer/Wyeth — $35 million. (2014)
•     Allergan/Warner Chilcott — $125 million and a criminal plea. (2015)

There's a very common drug-policy talking point that's meant to convey the absurdity of the war on drugs: Alcohol is more dangerous than marijuana, even though alcohol is legal and marijuana is not…Perhaps the biggest supporting evidence for this point is a 2010 study published in The Lancet that ranked alcohol as the most dangerous drug in the United Kingdom… Although drug policy experts generally don't dispute the assertion that alcohol is more dangerous than pot, the study, led by…David Nutt, is quite controversial. Experts see the rankings as deeply flawed, largely because they present the harms that come from drugs in a rather crude, one-dimensional manner. Even Nutt has acknowledged that the study is imperfect…There probably isn't a perfect way to evaluate and present all drug harms. Researchers will always need to balance making information simple and accessible for policymakers and the public with the inherent complexity of drugs and their effects. This makes the task of building scientific drug policies very challenging…The analysis may be flawed, but its simplicity and accessibility have won over many policy circles.

The news that UnitedHealth Group is considering leaving the new health insurance marketplaces established under the Affordable Care Act has prompted some concern about the their long-term viability...United Health Group’s possible departure is not really the issue. The insurer was a minor player in the individual market before the ACA passed, and currently covers only about 5 percent of marketplace enrollees…together with a few other developments, such as the failure of COOPs, the UnitedHealth Group announcement raised the fundamental question of whether the ACA marketplaces are enrolling sufficient numbers of people to ensure a well-balanced risk pool of healthy people and those with health problems. A pool where a majority of people have health problems could lead to higher premiums over time and destabilize marketplaces.

In an ideal world, doctors avoid outside influence and commit to ethical practice. However, they are also huge influencers in a for-profit pharmaceutical industry. This creates a breeding ground for potential conflicts of interest…In order to make relationships between health care providers and pharmaceutical companies more transparent, the Physician Payments Sunshine Act was enacted into law…Open Payments is the program that collects this information…Within this data, a pattern emerges: doctors who prescribe a lot of drugs tend to get more money from pharmaceutical companies…this data…identifies doctor and pharma relationships, it still does not determine causation. It only brings up certain questions: Are doctors prescribing specific drugs more because a pharmaceutical company is paying them? Or do pharma companies pay certain doctors because they prescribe a lot of their drugs? Further complicating the analysis is the knowledge that some physicians prescribe certain drugs in high volumes simply because they’re the best for their patients…While some argue that physicians should have nothing to do with drug marketing, others believe that collaboration between doctors and pharmaceutical companies is critical to improving the health and quality of life for patients. Not all doctors work simultaneously as drug prescribers and drug marketers, but those who do must strike a careful balance.

Kids and teens who take prescription medicines to treat attention-deficit hyperactivity disorder may be twice as likely to be bullied as their peers who don’t have this mental health problem… Adolescents who sold their prescribed drugs to other kids – who might want the stimulants for study or diet aids – had more than four times greater odds of being bullied than their peers without ADHD…Our findings show that there is some connection between a prescription for stimulant medications and bullying, even after accounting for the fact that adolescents with ADHD may have difficulties with peers or may have other problem behaviors associated with victimization…

Uruguayans will be able to choose from three varieties of state-sanctioned cannabis when marijuana starts being sold in pharmacies in the small South American country next year…Each variety will have different levels of...tetrahydrocannabinol and cannabidiol..."There will be three options with indications about the effects of each that point beginners toward starting with the lowest level" of THC...Uruguay became the first country to legalize the cultivation and distribution of marijuana in late 2013, aiming to wrest control of the trade from gangs while regulating and taxing its consumption…Authorities have developed traceable, genetically-distinct plants to ensure they do not leave Uruguay's borders or end up on the black market…The government estimates registered marijuana users will be able to buy the drug from pharmacies in mid-2016, when the country's two licensed producers start selling their first commercial load of about four tonnes…Authorities are also working with companies interested in exploring the possibility of exporting medical marijuana to the United States and Europe...